Anatomic Pathology: Neuropathology

794) This horizontal section of spinal cord, visualized with a silver stain, shows a lesion associated with:

• Tabes dorsalis involves selective degeneration of the dorsal spinal nerve roots and ganglia with associated degeneration of the posterior columns of the spinal cord.

• Tabes dorsalis can present 15 to 20 years after the initial syphilis infection as pain or paresthesias in the distribution of the involved nerve roots. With time, loss of pain and proprioceptive sensation can occur.

• The histologic findings include marked loss of neurons from the dorsal root ganglia, with associated proliferation of satellite cells and inflammatory cells (lymphocytes and plasma cells). As a result, secondary wallerian degeneration of the posterior column occurs.

• Tabes dorsalis can be seen in tertiary syphilis. Syphilis infection is caused by the spirochete Treponema pallidum and can be divided into three stages: primary (development of a chancre), secondary (maculopapular rash, condylomata lata), and tertiary syphilis (cardiovascular, ocular and gummatus forms).

• Involvement of the central nervous system (CNS) by syphilis can also include: syphilitic meningitis (1 to 2 years after infection with perivascular inflammation composed of plasma cells and lymphocytes) and gummatous neurosyphilis (solitary space-occupying lesions with central necrosis-gummas).

Ellison D, Love S, Chimelli L, et al (eds): Neuropathology: A Reference Text of CNS Pathology, 3rd ed. Edinburgh: Mosby Elsevier, 2013.

Love S, Louis DN, Ellison DW (eds): Greenfield’s Neuropathology, 8th ed. London: Hodder Arnold, 2008.

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